GP Stories - Testing Strips

Part of being a GP is unfortunately thinking of the bigger picture. We get guidance and directives from our big brother NICE, who make sure we give the most effective therapies clinically but also from a cost-effective point of view. Sadly this occasionally conflicts with the patient’s agenda and can lead to disagreements between doctors and patients.

One such disagreement occurred when I had a telephone consult with a newly diagnosed type 2 diabetic lady. Diabetes is a condition where the body can’t control the sugar levels in the blood, and it becomes too high. There are two types of diabetes; type 1 where the body doesn’t produce enough insulin and type 2 where your body doesn’t respond well to insulin. Insulin is the hormone that lowers the sugars in your blood. We treat it with a combination of diet, medication and sometimes synthetic insulin. However the problem with the treatments are that they can flip the blood sugars the wrong way, and you end up going too low and have a  ‘hypo’ – a potentially dangerous situation. Only certain medications have this effect, and if they do, we can prescribe testing strips for patients so they can regularly make sure they don’t drop their blood sugar.

This patient was on a medication called metformin that we know doesn’t cause hypos. As such, the guidance from NICE is that we do not routinely prescribe testing strips for these patients. However she was buying her own strips and testing her blood. She had read on internet forums and Facebook (sadly where a lot of medical knowledge seems to stem from) that metformin can cause hypos. She said that her blood sugars were low but she never got any symptoms from it. She wanted up to prescribe it for her (so she got it for free) but our guidance was to not prescribe it as she was not meant to be testing herself. She said the finance of buying the strips was causing her undue stress which was making her diabetes worse. I said I would bring it up at our clinical meeting, so when we had the meeting, the consensus amongst all the doctors was “No, we should not be prescribing testing strips for this woman.”

As you can imagine, she was livid when I told her. She said this was the worst practice and that she could end up in hospital due to potential hypos, and then proceeded to hang up abruptly. It’s never nice having a consultation end like that but with some patients, if they have a very fixed agenda they will never be happy unless they get what they want. I never did receive an ED discharge summary in the proceeding months with any hypo attacks of this patient. 

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